29.2 📚 國考版（醫師國考 / PGY OSCE）

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29.2.0.1 📌 Cram Sheet

29.2.0.1.1 🔥 高 yield 10 條

1. Delirium 3 features：acute fluctuating + 注意力 + cognition / consciousness 變
2. Hypoactive 50% 最常漏診
3. CAM 4 criteria = 1 + 2 + (3 or 4)
4. DELIRIUMS 病因
5. Haloperidol low-dose first-line（avoid in PD/Lewy）
6. BZD only for alcohol/BZD withdrawal（其他不用）
7. Alcohol withdrawal: BZD + thiamine BEFORE glucose
8. Multicomponent (HELP) 預防降 30-40%
9. Delirium superimposed on dementia 常被漏
10. CAM-ICU + RASS for ICU

29.2.0.1.2 🔢 必背

項目	數字
一般病房 delirium	14-30%
ICU delirium	> 80%
Mortality multiplier	~2×
Haloperidol dose	0.5-1 mg PO/IM
Lorazepam alcohol withdrawal	symptom-triggered (CIWA-Ar)
Thiamine	100 mg IV before glucose

29.2.0.1.3 ⚠️ 陷阱

• Hypoactive 漏
• BZD for non-withdrawal delirium
• Glucose before thiamine（Wernicke’s）
• Restraint 解躁動
• Lewy body dementia 給 haloperidol（嚴重 EPS）

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29.2.0.2 ⭐ 高 yield 摘要

29.2.0.2.1 CAM Algorithm

Required 1 + 2 + (3 OR 4): 1. Acute + fluctuating 2. Inattention 3. Disorganized thinking 4. Altered consciousness

29.2.0.2.2 DELIRIUMS Mnemonic（必背病因）

• Drugs / Electrolyte / Lack of drugs / Infection / Reduced sensory / Intracranial / Urinary / Metabolic / Sleep

29.2.0.2.3 Common Triggers in Elderly

• UTI
• Polypharmacy（特別 anticholinergic, BZD, opioid）
• Constipation
• Urinary retention
• Hypoxia
• Infection
• Surgery / anesthesia
• Sensory deprivation

29.2.0.2.4 Treatment Hierarchy

1. Identify + treat cause
2. Non-pharm：reorientation, sensory aids, mobilization, family
3. Pharm: haloperidol 0.5-1 mg first; quetiapine for PD/Lewy

29.2.0.2.5 Alcohol Withdrawal (DTs)

• CIWA-Ar score 監測
• Lorazepam IV symptom-triggered
• Thiamine 100 mg IV first（防 Wernicke’s）
• Folate + multivitamin
• IV fluid + electrolyte
• ICU if severe

29.2.0.2.6 Lewy Body / PD Caution

• 避 typical antipsychotic（haloperidol → severe EPS）
• 用 quetiapine, clozapine

29.2.0.2.7 Wernicke’s Encephalopathy

• 三聯: ophthalmoplegia + ataxia + confusion
• Korsakoff’s: amnesia + confabulation
• Treat: thiamine 500 mg IV q8h × 3 days

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29.2.0.3 🎯 自我檢測

1. CAM algorithm? → 1 + 2 + (3 or 4): Acute + 注意力 + (思緒混亂 OR 意識變)
2. Hypoactive 比例? → 50%
3. First-line antipsychotic? → Haloperidol low-dose
4. Alcohol withdrawal first? → Thiamine before glucose
5. PD/Lewy + delirium 用什麼? → Quetiapine / clozapine（避 haloperidol）
6. Wernicke triad? → Ophthalmoplegia + ataxia + confusion
7. ICU screening? → CAM-ICU + RASS

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